Precordial Exam
Precordial Exam
Please assess the student performing a complete precordial exam.
Student's Email:

GENERAL - Observe the student doing the following:

Washes hands
       
Introduces self and exam to patient
           
Appropriate draping of patient

Expose from the waist up. Intermittent exposure should be considered for female patients.

               

INSPECTION - The student should comment on the following:

Patient's general appearance

Ex: well/unwell, in distress etc

               
Masses, scars, lesions
               
Pulsations

Look in the Aortic, Pulmonic, Tricuspid, and Mitral areas for pulsations. Also look for heaves.

               
Apex beat

Look for presence of apex beat (5th intercostal space, midclavicular line)

               

PALPATION - Observe the student performing the following manoeuvers:

Apex beat

Comments on LADSLocation (5th IC space, midclavicular line), Amplitude (a "tap"), Duration (< 2/3 systole), Size (smaller than a quarter)

               
Heaves

Best palpated over the left sternal border with palm or heel of hand

               
Thrills

Palpate over aortic, pulmonic, tricuspid, & mitral valves for thrills

               

AUSCULTATION - Observe the student performing the following manoeuvers:

Auscultates the aortic valve

Located @ 2nd IC space at the right sternal border

               
Auscultates the pulmonic valve

Located @ 2nd IC space at the left sternal border

               
Auscultates the tricuspid valve

Located @ 4th IC space at the left sternal border

               
Auscultates the mitral valve

Located @ 5th IC space at the left midclavicular line

               
Auscultates using diaphragm & bell

Comments on utility of diaphragm vs bell

               
Comments on heart sounds

Normal - S1/S2, physiologic splitting of S2

Abnormal - S3/S4, murmurs

               
Palpates radial pulse while auscultating to distinguish between systolic/diastolic murmurs
               
Comments on presence/absence of murmurs
               

GLOBAL RATING SCALES - Please rate the student on their overall performance:

Understands rational of manoeuvers and findings
                   
Organized approach
                   
Sensitivity toward patient concerns and comfort during the examination